Provider Demographics
NPI:1700141330
Name:NEW ENGLAND PLASTIC SURGERY GROUP, LLC
Entity type:Organization
Organization Name:NEW ENGLAND PLASTIC SURGERY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINOD
Authorized Official - Middle Name:
Authorized Official - Last Name:PATHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-672-2824
Mailing Address - Street 1:8 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:OLD LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06371-1587
Mailing Address - Country:US
Mailing Address - Phone:718-672-2824
Mailing Address - Fax:718-672-3280
Practice Address - Street 1:8 VISTA DR
Practice Address - Street 2:
Practice Address - City:OLD LYME
Practice Address - State:CT
Practice Address - Zip Code:06371-1587
Practice Address - Country:US
Practice Address - Phone:718-672-3016
Practice Address - Fax:718-672-3280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty